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Original research
Effects of economic downturns on child mortality: a global economic analysis, 1981–2010
  1. Mahiben Maruthappu1,
  2. Robert A Watson2,
  3. Johnathan Watkins3,
  4. Thomas Zeltner4,
  5. Rosalind Raine5,
  6. Rifat Atun6
  1. 1Academic Clinical Fellow & Public Health Registrar, University College London, London, UK
  2. 2Department of Primary Healthcare and Public Health, Imperial College London, London, UK
  3. 3PILAR Research and Education, Cambridge, UK
  4. 4Global Health Centre, Graduate Institute of International and Development Studies, Geneva, Switzerland
  5. 5Head of Department of Applied Health Research, University College London, London, UK
  6. 6Harvard School of Public Health, Harvard University, Cambridge, Massachusetts, USA
  1. Correspondence to Dr Robert A Watson; robert.watson1{at}imperial.ac.uk

Abstract

Objectives To analyse how economic downturns affect child mortality both globally and among subgroups of countries of variable income levels.

Design Retrospective observational study using economic data from the World Bank's Development Indicators and Global Development Finance (2013 edition). Child mortality data were sourced from the Institute for Health Metrics and Evaluation.

Setting Global.

Participants 204 countries between 1981 and 2010.

Main outcome measures Child mortality, controlling for country-specific differences in political, healthcare, cultural, structural, educational and economic factors.

Results 197 countries experienced at least 1 economic downturn between 1981 and 2010, with a mean of 7.97 downturns per country (range 0–21; SD 0.45). At the global level, downturns were associated with significant (p<0.0001) deteriorations in each child mortality measure, in comparison with non-downturn years: neonatal (coefficient: 1.11, 95% CI 0.855 to 1.37), postneonatal (2.00, 95% CI 1.61 to 2.38), child (2.93, 95% CI 2.26 to 3.60) and under 5 years of age (5.44, 95% CI 4.31 to 6.58) mortality rates. Stronger (larger falls in the growth rate of gross domestic product/capita) and longer (lasting 2 years rather than 1) downturns were associated with larger significant deteriorations (p<0.001). During economic downturns, countries in the poorest quartile experienced ∼1½ times greater deterioration in neonatal mortality, compared with their own baseline; a 3-fold deterioration in postneonatal mortality; a 9-fold deterioration in child mortality and a 3-fold deterioration in under-5 mortality, than countries in the wealthiest quartile (p<0.0005). For 1–5 years after downturns ended, each mortality measure continued to display significant deteriorations (p<0.0001).

Conclusions Economic downturns occur frequently and are associated with significant deteriorations in child mortality, with worse declines in lower income countries.

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

https://doi.org/10.1136/bmjgh-2016-000157

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    Footnotes

    • Handling editor Sanni Yaya.

    • Disclaimer The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health.

    • Contributors MM, RA and TZ were involved in study concept and design; MM, RA, TZ, JW, RAW and RR were involved in data analysis and interpretation; MM, RA, TZ, JW, RAW and RR were involved in manuscript preparation and revision. All authors had full access to all of the data in the study and can take responsibility for the integrity of the data and the accuracy of the data analysis. The lead author (MM; the manuscript's guarantor) affirms that the manuscript is an honest, accurate and transparent account of the study being reported; and that any discrepancies from the study as planned (and, if relevant, registered) have been explained.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement All data used are publicly available. Links are provided in the manuscript.